Poor ICD-10 Z codes. All the way at the end of the code list and often overlooked. They don’t even get the attention W codes do for interesting adventures involving turtles.
But Z codes do have an important role to play, and today we’re going to show them some love. Let’s look at what these codes have to offer for optometry and ophthalmology services.
1. Know When to Use Routine and Admin Exam Codes
Z codes are in Chapter 21, Factors Influencing Health Status and Contact With Health Services. As the chapter name implies, the codes indicate the reason for an encounter. For eye care, be sure you get to know these codes for routine and administrative examinations:
- Z01.00, Encounter for examination of eyes and vision without abnormal findings
- Z01.01, Encounter for examination of eyes and vision with abnormal findings
- Z02.4, Encounter for examination for driving license.
OG tips: The ICD-10 Official Guidelines (OGs) explain that you should not use these codes if the exam “is for diagnosis of a suspected condition or for treatment purposes.” Use the appropriate diagnosis code in those cases.
The OGs list Z00 and Z01 as categories you may report only as the principal/first-listed diagnosis unless the patient has more than one encounter on that date with combined medical records.
If the provider discovers a condition during the exam, you should report that as an additional code (such as in addition to Z01.01). Choose your codes based on what you know at the time you’re coding. For instance, you can report Z01.00 for no abnormal findings even if test results aren’t in yet.
2. Support Treatment Decisions With Z Codes
Smart coders know when to use Z codes to help tell the story of the patient encounter.
Example: An ophthalmologist spends extra time examining a patient with a history of gestational diabetes during multiple pregnancies. You use Z86.32 (Personal history of gestational diabetes) as an additional diagnosis code to explain the higher level service provided to check for any indications of retinopathy.
Z codes don’t guarantee coverage by any means, but the reality is accurate, compliant coding doesn’t always guarantee coverage.
Just remember to select Z codes based on what’s relevant to the current encounter and what affects patient management.
3. Don’t Double Up on Transplant Codes
You’ll find status codes starting with Z, too, like, Z94.7 (Corneal transplant status). But if you’re reporting another ICD-10 code that refers to the transplant status, you should not report the Z status code, according to both the OGs and an Excludes1 note with category Z94.-.
Example: If you’re reporting a code from subcategory T86.84- (Complications of corneal transplant), you should not also report Z94.7. The T86.84- codes make it clear that the patient has a corneal transplant, so using Z94.7 adds no information to the claim.
How About You?
When do you use Z codes? Have you encountered any problems using these codes? How do you remember to use these codes correctly?